Building our family through IVF

Mr. Hopeful Explains What It’s Like To Have A MESA/ TESE Procedure

The purpose of this post, dear reader, is to relay experience gained through two separate procedures—two MESAs and one TESE—in hopes of helping my fellow men who may be facing similar procedures as a result of male factor infertility. Prior to my first MESA procedure, I scoured the Internet trying to gain a sense of what to expect, yet all I came up with was technical jargon and basic explanations. As such, I’m providing this boots-on-the-ground narrative in an attempt to help shed light on the procedures and educate others as to what to expect.

Fair warning: the following contains graphic content. Prior to my first MESA procedure, I would have loved to read a no-B.S. assessment of what I was getting myself into. As such, I’ve written this post in the same straight-up, conversational manner that I’d use if talking to another man about the topic. I’ve used jargon that you may find offensive. There’s definitely TMI contained in the following paragraphs, and if you have a weak stomach, are easily grossed out/offended, or just plain don’t want to read a firsthand description of what it’s like to have a testicle cut open, you’d better skip this blog.

A note to all the women who may read this blog: I am under no false illusions that your involvement in the IVF process is immeasurably harder and more physically uncomfortable, humiliating, and demanding that mine—and that’s before you (hopefully) carry and deliver a baby! In no way am I trying to diminish your contribution by describing what I have been through; I’m merely trying to accurately convey my experience in hopes of taking some of the fear and mystery out of the procedure(s) for the benefit of other men. I’ll be the first to admit that men are tough…but women are much, much tougher!

OK, now that you’ve been warned/notified, let’s get started:

My first procedure was scheduled to be a MESA—short for Microsurgical Retrieval of Epididymal Sperm—or, as I read it in my head every time, “Mildly Embarrassing Sperm Acquisition.” Those of you who have followed our blog will likely remember that I was born with congenital absence of the vas deferens, meaning that I don’t have any tubes connecting my nuts to the rest of the system. Translation? I produce sperm but don’t deliver it, meaning that in order to get my half of the IVF recipe, my urologist needs to physically retrieve it. Lucky me.

Dr. W is without a doubt one of the best male fertility specialists in the business. At about six-and-a-half feet tall, he’s also likely one of the biggest. I felt comfortable from the moment that I met him, and he assured me that he would do everything in his power to make the procedure a successful one.

My balls—and our reproductive future—were soon in his large and competent hands.

Although I’ve done this procedure twice at two different IVF clinics, both times Dr. W traveled to the clinic to perform the procedure. For the sake of eliminating redundancy, I’ll describe the second, more successful procedure, adding in notes from the first when relevant.

The day of the second procedure also marked my wife’s retrieval, since we didn’t want to have to freeze my sperm. She went first, and I sat quietly in the waiting room and kept a good thought for both of us. I have had a number of surgeries in my life and wasn’t too nervous, but I definitely felt my adrenaline spike when they asked me to come in back and start getting ready.

Heather was already in recovery at that point, and I filled out paperwork while doing my best to take care of her. Pretty soon, the nurses opened up the curtain divider to reveal another hospital bed, and asked me to get changed into a gown and socks that were sitting in a neat pile. I couldn’t help but laugh at the nurse’s attempt at modesty when she came back and asked through the curtain if I was changed and decent. Really, lady? I thought. You’re about to see my junk under an 800 lumen light, and you want to make sure I’m dressed? I played along and after kissing my still-drugged wife and taking a quick piss for good luck, it was off to the operating room.

Dr. W had already arrived and was prepping his tools while singing along to an obscure ’70s hit song that was blasting through the overhead speaker in the room. With the help of a nurse, he directed me to lie down on the main operating table with an array of pillows jammed underneath my head and shoulders to keep me from moving around (and, I suspect, watching).

At this point, I asked for a blanket for my chest. Now, my cold tolerance is insane, but I have very little body fat, and the room was cool enough that I knew I’d be shaking like a jackhammer in about ten minutes if I didn’t have more insulation (normally I’d be content to just shiver, but given that in the next ten minutes I’d have needles and razors applied to my scrotum, I opted for the snivel gear).

With the same casual familiarity of a professional chef flipping a pancake, Dr. W flipped back the gown to reveal my family jewels. I glanced at the nurse to gauge her reaction; she looked about as unsurprised as a librarian walking past a shelf full of books. I took this to be a good thing and tried to prep myself for what I knew was coming.

The first thing Dr. W did was compliment me on the job I’d done shaving “the area.” I’ve had enough surgeries to know the drill, and he seemed as happy to not have to shave my sack as I was. Next, Dr. W warned that things would get “cold and wet” and proceeded to dump what felt like a 5-gallon bucket of ice-cold liquid iodine on my crotch. I felt myself inhale sharply as the iodine ran down my legs and all over the place, and soon Dr. W was smearing it around in as professional a manner as one can when smearing a slippery liquid over another man’s crotch. Next, Dr. W used some scotch tape—yes, the same stuff we all used in elementary school to hang up pictures—to tape my shaft to my stomach. I was happy to have it out of the way (not that either he or the nurse would slip with a kitchen knife—but hey, better safe than sorry!).

Dr. W then asked if I was ready to get started, and warned that I’d feel a “pinch and a burn” as he numbed the area. Now, there are many ways to describe having a needle stuck into one of the most sensitive spots on your body, and pinch and a burn is not the first that comes to mind. I bit my lip and reminded myself that my wife has had to endure similar experiences, and at a far greater frequency than this. Dr. W numbed the area to his liking. While I couldn’t feel the incision—or anything in that general region, for that matter—I could feel it in my stomach (every guy knows that if you get hit in the balls hard enough, your stomach hurts. This came on as a dull but bearable ache that remains for about a week or two).

At this point, Dr. W’s next actions aren’t entirely known to me, since I wasn’t directly watching (nor did I want to be) and, thankfully, I couldn’t feel much more than a muted tugging and slight pressure. I could tell that he was cutting into my skin and epididymis to retrieve a sample. The first time I had this done, the clinic-supplied nurse was borderline incompetent. While Dr. W pushed “fluid” out of the epididymis, she sucked it up with a syringe. Or, at least she pushed it around while Dr. W futility attempted to coach her through the process. Later, when she left the room, I asked if she was qualified to do this procedure. He said that she was but I could sense his frustration at her inability to do what he needed her to do.

Fortunately, the second nurse—whom I’m guessing is an employee of our current IVF clinic—was an absolute pro. She did exactly what Dr. W needed her to do, and soon he was leaving the room to view the sample under a microscope with the lab techs. I noticed that a second female nurse had entered the room. All modesty had left us at that point; whether she was there to help—or just view my fine china—I really didn’t care. We made awkward conversation while I stared at the vent in the ceiling wondering what bacteria was flowing into the room and my still-splayed-open nutsack.

The first time we did this procedure, Dr. W came shuffling into the room 10 minutes later and explained that he’d only found dead sperm. In the next few minutes, my MESA procedure became a TESE (Testicular Sperm Extraction or, as I came to refer to it, Total Emergency Sperm Exploration) as Dr. W went directly into my nut to try to get what he needed. Several trips back and forth to the lab and he had a few “twitching” sperm, but I could tell he wasn’t pleased.

Fortunately, my second procedure was completely different. I’d been taking daily fistfuls of supplements for months in hopes of raising my sperm quality; in the process, I’d become incredibly moody and I’d put on about 8 pounds of muscle (understandable, since my testosterone was through the roof and I was, in effect, juicing). But this regiment of chemicals resulted in a body composition change that fired up my little swimmers in a big way.

Soon, Dr. W came bursting into the room like Kramer from Seinfeld and proudly announced that I had millions of sperm. Millions! He said that the lab techs were high-fiving each other, and the sample looked so good that it could have come from a normal ejaculation. Words cannot convey how utterly relieved we both were to hear this result. As Dr. W jostled some tools and papers around the operating room, my thoughts returned to my wife, who had since left the clinic under the care of a friend to get some much-needed rest. I couldn’t wait to tell her the positive news, and that I felt like we were “back in the game” as far as becoming parents to our own children. Coincidentally, I noticed that the song that was now blasting through the overhead speaker was “All You Need Is Love” by The Beatles. I can tell you this: if this cycle is successful, that song will never sound quite the same as it did before this procedure.

It wasn’t long before Dr. W began buttoning things up. He was smiling and very upbeat; I was pleased to see that he was truly invested in a positive outcome for us. Now that the pressure was seemingly off, we began casually conversing about a variety of manly topics—our shared affinity for martial arts, the folly of trying to out-swim a Navy SEAL BUD/S instructor, and the prevalence of Kalashnikov rifles in third world countries were all discussed as he stitched up my still-numb junk. The tough-guy conversation was likely not unintentional; I suspect that it was our shared way of acknowledging each other and saying, Look, this is as close to pillow talk as IVF gets. Neither of us particularly enjoyed this, but we’re both damn happy with how it went. Let’s get this done and be through with it.

The administering of the sutures was unpleasant (each time he tugged on the string, my boys momentarily left the surface of the table, like an adult-themed puppet covered in drying iodine). Again, Dr. W’s competence and professionalism ruled out, and he was finished before I knew it. The nurse left the room, and without further instructions I gently pulled all of the blankets to the ground and, after a sincere thank-you and a firm handshake with my towering doctor, I shuffled for the recovery room, where I quickly ditched my iodine-and-who-knows-what-else-stained gown and donned a set of tri-shorts (I’ve found these offer the best post-procedure support; jock straps can be a little too tight and actually hurt a little if they get out of place). The nurses gave me a few ice-packs, which I gratefully shoved down my shorts, and after waving off additional pain meds and throwing on the rest of my clothes, I was soon out on the curb and grabbing a ride from our friend. We then drove to pickup my wife, at which point I got behind the wheel and piloted us home. You’re technically not supposed to drive after this procedure, but if I was going to be sitting, I figured I might as well drive. Plus, my dear wife was still looped out from her procedure.

This photo was taken of my immediately following my first MESA procedure. As you can see, I was a little rattled by the experience.

As the local anesthetic wore off and we arrived at home, I found myself in quite a bit of pain, but nothing that lying down and icing—combined with a single Tylenol—didn’t fix. In the next 24 hours, I ran a few errands to pickup take-out and to get my antibiotics from the pharmacy, but otherwise I stayed put and let the ice do its work (frequent icing is key to managing the swelling). Walking was a ginger affair for about two days, but within four days I was back at work (which entailed me being in disgusting, dirty, frigid ocean water while wearing an exposure suit doing mock emergency swimmer ascents from an imaginary submarine. Hurray for antibiotics!) Suffice it to say, nobody at work knew what I had been through, and within five days of my procedure I was riding a mountain bike (much to my wife’s chagrin. But to be honest, she knew what she was getting into when she married me).

Final note: I slept with a pillow between my knees for about ten days. The stitches go away on their own after a few weeks. About the time you get used to them, you realize that they’ve fallen out or dissolved or something.

And that, my friends, is what it’s like to have a MESA procedure. Let’s hope that it wasn’t for nothing!

Though I’ll never have to use this info, I found it to be very interesting, and I’m sure a lot of others will be thankful to have such an honest review of what to expect. Wtg on those second round swimmer results! That’s so great! I’m very excited for you & Heather! 🙂

This was really interesting, thank you for sharing.
To be quite honest, this sounds a whole lot worse than an egg retrieval…at least I wasn’t aware of what they were doing when I was sedated- I cannot imagine anything worse than be aware of every little thing of what’s happening down there…
I am also super impressed that you were on a mountain bike 5 days after!

Thank you for the comment, the experience was definitely interesting. One upside to being awake was that I was aware of how it was going, and that I didn’t need to wait until after to find out how it went. That part was a plus, I guess!

Yep, that’s him. I have nothing but great things to say about Dr. Werthman; he’s insanely good at his job and is very knowledgable, friendly, and professional. I’d definitely refer anyone looking for a good urologist to him.

It’s interesting how different my husband’s TESE was from yours. He was completely under, his stitches were internal so he never felt anything, and he says he was never in pain, just uncomfortable from the swelling. The swelling went down in about 2 weeks and by five weeks he was completely recovered, no surgical ridge or scarring left behind. Although, they didn’t dig around in him very long because they could tell right away there wasn’t anything.

Hi Kellie, I’m so sorry I just saw your comment. There are not any surgery options to date, but this does not limit him from having children. Hopefully by the time he’s ready for a family technology will have advanced too!